Provider Demographics
NPI:1093576134
Name:WITHERS, JAMONICA
Entity Type:Individual
Prefix:
First Name:JAMONICA
Middle Name:
Last Name:WITHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4042 TELLMONT CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9465
Mailing Address - Country:US
Mailing Address - Phone:336-337-5731
Mailing Address - Fax:
Practice Address - Street 1:4042 TELLMONT CT
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9465
Practice Address - Country:US
Practice Address - Phone:336-337-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician